Health Care Delivery and Health Policy: Meeting a Woman's Needs
Research has demonstrated over and over again that access to, and utilization of, medical services are not uniform in our population. While BCRP is working to advance new prevention strategies and treatments for breast cancer, we are also committed to investing in research that will make these available and acceptable to all populations in California. Despite the small number of grants BCRP has funded in the Health Policy Area, its interest in funding such research remains keen and it will continue to solicit and encourage applications in this area.
Research Conclusions
The Medical System
Breast-conserving surgery (BCS) is an equally effective alternative to mastectomy for most women with stage I or II breast cancer, and is now the recommended alternative for these cases. However, 37% of women with small early stage tumors still received a mastectomy in 1996. The physical and psychological impact associated with unnecessary mastectomies represent a human cost that can be minimized by understanding which factors affect the choice of surgical treatment. Cyllene R. Morris, DVM, MPVM, Ph.D. of the Public Health Institute undertook to:
- determine statewide trends of utilization of breast-conserving surgery;
- determine the most significant predictors of choice of surgery for women who are eligible for breast-conserving surgery; and
- compare the five-year survival experience of women receiving breast-conserving surgery to the survival of women eligible for breast-conserving surgery who receive mastectomies.
Her analysis indicated that women who are of Asian or Hispanic race/ethnicity, 65 years and older, currently married, diagnosed with a centrally located, stage II lobular or comedo carcinoma, residing in less affluent areas, or in a county without a radiation facility are the least likely to receive breast-conserving surgery in California. On the other hand, African American women are more likely to receive breast-conserving surgery than women of any other race/ethnicity were. Despite these differences, use of breast-conserving surgery is increasing steadily in California. The rate of increase in breast-conserving surgery is similar among women of all race/ethnic groups, and is also similar regardless of the socioeconomic status in the patient's neighborhood. Further analysis of these data is underway and will be published shortly.
Research In Progress
Reducing Inequities
Despite the high incidence of breast cancer and low levels of both awareness and utilization of screening and early detection examinations, no educational programs have been tested among Samoan women. Shiraz I. Mishra, M.D., Ph.D. of the University of California, Irvine and Pat Luce-Aoelua, M.S., of the National Office of Samoan Affairs are implementing an innovative, theory-based, culturally sensitive and linguistically appropriate breast cancer educational program specially developed for Samoan women. They are implementing the intervention and evaluating its effectiveness in enhancing knowledge, modifying attitudes, and most importantly, effecting positive behavior change. During the first year, they developed the educational program, constituted the sample frame of 68 Samoan speaking churches in Los Angeles and Orange counties, and began implementation of the study in 11 of these churches.
